Kusvirwa, murwere akashata sei? Ongororo neWallace's Rule of Nine

By Cristiano Antonino On Apr 26, 2023

Mutemo weNine, unozivikanwawo seWallace's Rule yeNine, chishandiso chinoshandiswa mukushungurudzika uye mushonga wekukurumidzira kuongorora iyo yakazara muviri nzvimbo (TBSA) inobatanidzwa mukupisa varwere.

Kutarisana nechiitiko chekukurumidzira chinosanganisira mukana wekutsva kwakanyanya kunoguma nekumwe kukurumidza kwekuongorora.

Saka zvakakosha kuti muponesi ave neruzivo rwekutanga runoita kuti akwanise kunyatsogadzira munhu anenge atsva.

Kuyera nzvimbo yekutanga yekutsva kwakakosha pakufungidzira kudzoreredzwa kwemvura kunodiwa sezvo varwere vane kutsva kwakanyanya vachaona kurasikirwa kukuru kwemvura nekuda kwekubviswa kwechivharo cheganda.

Ichi chishandiso chinongoshandiswa pakutsva kwechipiri-uye chechitatu-dhigirii (inozivikanwawo sechikamu-ukobvu uye kuzara-kupisa kwekupisa) uye inobatsira mupi mukuongorora nekukurumidza kuona kuomarara uye kudiwa kwemvura.

Kugadziriswa kuMutemo weNine kunogona kuitwa zvinoenderana nemuviri misa index (BMI) uye zera

Mutemo weNine wakaratidza kuva algorithm inonyanya kudzokororwa navanachiremba uye vanamukoti kuti vafungidzire kutsva nzvimbo muzvidzidzo zvakawanda.[1][2][3]

Mutemo weNine fungidziro yenzvimbo yakatsva yemuviri inobva pakugovera zvikamu kubva muzana kunzvimbo dzakasiyana dzemuviri.

Musoro wese unofungidzirwa pa9% (4.5% yekumberi nekumashure).

Iyo torso yese inofungidzirwa pa36% uye inogona kukamurwazve kuita 18% yekumberi uye 18% yekumashure.

Iyo yepamberi chikamu chehunde inogona zvakare kukamurwa kuita thorax (9%) uye dumbu (9%).

Iyo yekumusoro inokwana 18% uyezve 9% kune yega yega yepamusoro. Chimwe nechimwe chepamusoro chepamusoro chinogona kuwedzera kugoverwa kuva anterior (4.5%) uye shure (4.5%).

Mitezo yepasi inofungidzirwa pa 36%, 18% kune imwe neimwe yezasi.

Zvakare izvi zvinogona kugovaniswazve kuita 9% yeanterior aspect uye 9% yekumashure.

Chidziyo chinofungidzirwa kuva 1%. [4][5]

Basa reKutonga kweMapfumbamwe

Mutemo weNine unoshanda sechishandiso chekuongorora chechipiri-uye chechitatu-degree yakazara muviri wepamusoro nzvimbo (TBSA) muvarwere vanopisa.

Kana TBSA ichinge yatemwa uye murwere adzikamiswa, kudzoreredzwa kwemvura kunowanzotanga nekushandiswa kwefomula.

Iyo Parkland formula inowanzoshandiswa.

Inoverengerwa se4 ml intravenous (IV) fluid pakirogiramu yehuremu hwemuviri hwakakodzera pachikamu cheTBSA (inoratidzwa sedesimali) kwemaawa makumi maviri nemana.

Nekuda kwemishumo yekumutsiridza zvakanyanya, mamwe mafomati akatsanangurwa senge yakagadziridzwa Brooke formula, inoderedza IV fluid kusvika 2 ml pane 4 ml.

Mushure mekuisa huwandu hwese hwekumutsiridza nemvura inopinza kwemaawa makumi maviri nemana ekutanga, hafu yekutanga yevhoriyamu inopihwa mumaawa masere ekutanga uye imwe hafu inopihwa mumaawa gumi nematanhatu anotevera (izvi zvinoshandurwa kuita chiyero cheawa imwe nekukamura. hafu yehuwandu hwehuwandu hwe24 uye 8).

Iyo 24-hour volume nguva inotanga panguva yekutsva.

Kana murwere achipa maawa maviri mushure mekupisa uye kudzorerwa kwemvura kusati kwatangwa, hafu yekutanga yevhoriyamu inofanira kuiswa mumaawa e2 nehafu yakasara yemvura inoshandiswa maererano neprotocol.

Fluid resuscitation inokosha zvikuru mukutanga kutarirwa kwekutsva kwechipiri-nechitatu-degree kunosanganisira zvinopfuura 20 muzana yeTBSA sezvo matambudziko ekukundikana kwetsvo, myoglobinuria, haemoglobinuria uye kukanganisa kwenhengo dzakawanda zvinogona kuitika kana zvikasakurumidza kurapwa zvakasimba.

Kufa kwakaratidzwa kuva kwakakwirira muvarwere vane TBSA inopisa kupfuura 20% vasingagamuchire kumutswa kwemvura kwakakodzera pakarepo mushure mekukuvara.[6][7][8]

Pane kushushikana pakati pevarapi nezve huchokwadi hweRule reNine kune vakafutisa uye vana vevanhu.

Mutemo weNine unogona kushandiswa zvakanakisisa kune varwere vanorema kupfuura 10 kilograms uye pasi pe80 kilograms kana inotsanangurwa neBMI seyakaderera pane yakanyanyisa.

Kune vacheche uye varwere vakafutisa, kutarisisa kwakanyanya kunofanirwa kubhadharwa kune zvinotevera:

Varwere vakafuta

Varwere vanotsanangurwa sevakafutisa neBMI vane hunde dzakakura zvisingaenzaniswi kana vachienzaniswa nevasina kukora.

Varwere vakafuta vane padyo ne50% TBSA yehunde, 15% TBSA pagumbo rega rega, 7% TBSA paruoko rumwe norumwe uye 6% TBSA yemusoro.

Varwere vakaumbwa neAndroid, vanotsanangurwa seyakasarudzika kugovera hunde uye yekumusoro muviri adipose tishu (dumbu, chipfuva, mapendekete uye mutsipa), vane hunde iri pedyo ne53% TBSA.

Varwere vane gynoid shape, inotsanangurwa seyakasarudzika kugoverwa kweadipose tishu muzasi memuviri (pasi pedumbu, pelvis uye zvidya), vane hunde iri padyo ne48% TBSA.

Sezvo dhigirii yekufutisa inowedzera, dhigirii rekuderera kweTBSA kubatanidzwa kwehunde nemakumbo kunowedzera pakuomerera kuMutemo weNine.

Vana vacheche

Vacheche vane misoro mihombe zvakaenzanirana inoshandura kupa pamusoro pemamwe mativi makuru emuviri.

A 'Rule of Eight' wakanakira vacheche vane huremu huri pasi pegumi makirogiramu.

Mutemo uyu unomanikidza TBSA ingangoita 32% pahunde yemurwere, 20% TBSA yemusoro, 16% TBSA pagumbo rega rega uye 8% TBSA paruoko rumwe norumwe.

Pasinei nekushanda kweMutemo weNine uye kupinda kwayo mumishonga yekuvhiya uye yekukurumidzira, zvidzidzo zvinoratidza kuti pa 25% TBSA, 30% TBSA uye 35% TBSA, chikamu cheTBSA chakanyanyisa ne20% zvichienzaniswa nemakombiyuta-based applications.

Kuwedzeredza kweTBSA yakatsva kunogona kukonzera kudzoreredzwa kwakanyanya nemvura inopinza, zvichipa mukana wekuremerwa kwevhoriyamu uye pulmonary edema nekuwedzera kudiwa kwemoyo.

Varwere vane zvirwere zvakagara zviripo vari panjodzi yekuora mwoyo kwakanyanya uye kufema uye vanofanirwa kutariswa mukamuri yevanorwara zvakanyanya (ICU) panguva yehasha yekumutsiridza mvura, zviri nani munzvimbo inotsva.[9][10]

Mutemo weNine chishandiso chinokurumidza uye chiri nyore chinoshandiswa kune yekutanga manejimendi yekumutsidzira muvarwere vakatsva

Zvidzidzo zvakawana kuti mushure mekuongorora murwere asina kupfekedzwa zvakakwana, chikamu cheTBSA chinogona kutariswa neMutemo weNine mukati memaminitsi.

Ongororo dzinoverengeka dzakawanikwa muongororo yemabhuku dzakataura kuti chanza chemurwere, kusasanganisa zvigunwe, chakaverengera chinenge 0.5 muzana TBSA uye kuti ongororo yakaonekwa nemakomputa-based application.

Kuiswa kweminwe muchanza kunoda kusvika 0.8% TBSA.

Kushandiswa kwechindwe, iyo ndiyo nheyo iyo Mutemo weNine yakasimbiswa, inofungidzirwa kuti yakakodzera kune zviduku zviduku zvechipiri-uye chechitatu-degree.

Izvo zvave zvichicherechedzwa kuti iyo yakanyanya kudzidziswa nyanzvi ine, yakaderera iyo overestimation, kunyanya pakutsva kudiki.

Mamwe matambudziko

Nekuda kwehunhu hwechikanganiso mukupisa kwevanhu ongororo kunyangwe mukumisikidzwa kwemitemo, macomputer-akavakirwa maapplication anowanikwa emafoni anogadzirwa kuti aderedze kudarika- uye kushomeka kwemazinga eTBSA.

Iwo maapplication anoshandisa akamisikidzwa saizi yediki, yepakati uye yakafutisa varume nevakadzi modhi.

Zvikumbiro zviri kufambawo kune zviyero zvevachangozvarwa.

Zvishandiso zvemakombuta izvi zviri kusangana nekusiyana-siyana mukushuma kweTBSA mazinga anosvika makumi matanhatu kubva muzana ekufungidzira kwenzvimbo yakatsva kusvika pamakumi manomwe kubva muzana.

Intravenous fluid resuscitation inotungamirirwa neRule yeNine inongoshanda kune varwere vane TBSA muzana pamusoro pe20% uye varwere ava vanofanira kuendeswa kunzvimbo yepedyo yekutambudzika.

Kunze kwenzvimbo dzakakosha, dzakadai sechiso, nhengo dzesikarudzi nemaoko, izvo zvinofanirwa kuonekwa nenyanzvi, kuendesa kunzvimbo huru dzekutambudzika kunongodiwa kune zvinopfuura 20% TBSA inopisa.

IAmerican Burn Association (ABA) yakatsanangurawo maitiro ekuti varwere vaendeswe kunzvimbo inotsva.

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Kana kudzoreredzwa kwemvura kwatanga, zvakakosha kuti uone kana kwakakodzera perfusion, hydration uye renal basa riripo.

Kudzoserwa kunobva muMutemo weNine uye intravenous fluid formula (Parkland, Brooke yakagadziridzwa, pakati pevamwe) inofanira kunyatsoongororwa uye kugadziriswa sezvo aya maitiro ekutanga ari mazano.

Kutarisira kwekupisa kwakanyanya inzira yemvura inoda kugara ichitariswa uye kugadzirisa.

Kusatarisisa kune zvakadzama kunogona kukonzera kuwedzera kwehurwere uye kufa sezvo varwere ava vari kurwara zvakanyanya.

Mutemo weNine, unozivikanwawo seWallace's Rule yeNine, chishandiso chinoshandiswa nevashandi vehutano kuongorora iyo yakazara muviri nzvimbo (TBSA) inobatanidzwa mukupisa varwere.

Kuyerwa kwenzvimbo yekutanga yekutsva neboka rehutano kwakakosha pakufungidzira kudzoreredzwa kwemvura kunodiwa nekuti varwere vakatsva zvakanyanya vane kurasikirwa kukuru kwemvura nekuda kwekubviswa kwechivharo cheganda.

Chiitiko ichi chinogadziridza zvikwata zvehutano pakushandiswa kweRule rweNine muvanopiswa izvo zvinoburitsa zvirinani kuvarwere. [Chikamu V].

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